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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2015

Coverage for Artificial Cervical Disc Replacement with Prior Authorization 


For dates of service beginning July 1, 2015, Harvard Pilgrim Health Care will now offer coverage for artificial cervical disc replacement in select patients, provided that prior authorization is obtained from our partner National Imaging Associates, Inc. (NIA). This change applies for members enrolled in our fully insured commercial products (such as HMO, PPO, Access America, etc.).

Artificial cervical disc replacement is performed as part of total disc replacement, a procedure in which a degenerative cervical disc is removed and replaced with an artificial cervical disc. The artificial cervical disc relieves pain, restores disc height, maintains motion of the natural spine, and prevents degeneration of adjacent discs. Total disc replacement was developed as an alternative to anterior cervical discectomy and fusion (ACDF).

Harvard Pilgrim made the determination to cover the following procedure after a clinical review found that cervical total disc replacement is now considered an effective and appropriate treatment for some patients:

  • 22856 – Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical

Please refer to the Artificial Cervical Disc Replacement Medical Policy for Harvard Pilgrim’s clinical criteria for this procedure.

Ordering physicians will be responsible for obtaining prior authorization. You may request prior authorization for artificial cervical disc replacement through the NIA website (www.RadMD.com) or by phone (800-642-7543). You can check on the status of authorization requests quickly and easily on the www.RadMD.com website by selecting the “My Exam Requests” tab to view outstanding authorizations for spine procedures.

Claims will continue to go directly to Harvard Pilgrim, and providers are encouraged to submit claims using our preferred e-channels HPHConnect, NEHENNet, NEHEN or EDI-Direct — or by mail to the following address:

Harvard Pilgrim Health Care
P.O. Box 699183
Quincy, MA 02269-9183

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PUBLICATION INFORMATION

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Writer

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Production Coordinator